<form action="{:url()}" method="post" class="form_single">
    <div class="box">
      <div class="box-body">
        <div class="row">
          <div class="col-md-6">
            <div class="form-group">
              <label>名称</label>
              <span>（地名名称）</span>
              <input class="form-control" name="name" placeholder="请输入名称" value="{$info['name']|default=''}" type="text">
            </div>
          </div>
            <div class="col-md-6">
                <div class="form-group">
                    <label>编码</label>
                    <span>（地方编码）</span>
                    <input class="form-control" name="code" placeholder="请输入地方编码" value="{$info['code']|default=''}" type="number">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <label>市级名称</label>
                    <span>（市级地名）</span>
                    <input class="form-control" name="city_name" placeholder="请输入市级名称" value="{$info['city_name']|default='-'}" type="text">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <label>市级编码</label>
                    <span>（市级编码）</span>
                    <input class="form-control" name="city_code" placeholder="请输入编码" value="{$info['city_code']|default='00'}" type="number">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <label>省级名称</label>
                    <span>（省级名称）</span>
                    <input class="form-control" name="province_name" placeholder="请输入省级编码" value="{$info['province_name']|default='-'}" type="text">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <label>省级编码</label>
                    <span>（市级编码）</span>
                    <input class="form-control" name="province_code" placeholder="请输入数量" value="{$info['province_code']|default='00'}" type="number">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <label>级别</label>
                    <span>（省市区）</span>
                    <div>
                        <label class="margin-r-5"><input type="radio" name="level" value="1"> 省级</label>
                        <label><input type="radio" name="level"  value="2"> 市级</label>
                        <label><input type="radio" name="level"  value="3"> 区/县级</label>
                    </div>
                </div>
            </div>
        </div>
      </div>
      <div class="box-footer">
        
        <button  type="submit" class="btn ladda-button ajax-post" data-style="slide-up" target-form="form_single">
            <span class="ladda-label"><i class="fa fa-send"></i> 确 定</span>
        </button>

        <a class="btn" href="javascript:history.back(-1)"><i class="fa fa-history"></i> 返 回</a>
        
      </div>
    </div>
</form>
<script type="text/javascript">

    ob.setValue("level", {$info.level|default=0});

</script>